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- <br /> CHAII 1OF CUSTODY RECORD Pg of - <br /> FOR LABORATORY USE ONLY <br /> Advanced Technology <br /> Method of Transport Sample Condition Upon Receipt <br /> Laboratories P O# ATL t 1 CHILLED L Y ❑ 4 SEALED Y ❑ N..R *IJA44A <br /> 3275 Walnut Avenue 11 CA OverN ❑ 2 HEADSPACE(VOA) Y A❑ 5 #OF SPLS MATCH COC Y tXN ❑ <br /> Signal Hill,CA 90807 Logged By 1 Date FEDEX El <br /> (562)989-4045 • Fax (562)989-4040 Other 3 CONTAINER INTACT YoN❑ 6 PRESERVED Y © N Iff <br /> Client 45"�e0c /, I Address TEL { ) <br /> r <br /> Attn Ina Ciry 11 y ie Zip Code FAX{ ) <br /> Protect Name Pro)eci# g i' 2II O Sampler IP�'Rt� m <br /> Relinquished by mea Date O J iI TimieO ;![ eceived by tsignamre and Prated Name) ate Time . a <br /> Ar <br /> Relinquished by tsrgnai..and Pnniad ma) Date j I'll JlTime Received by (sgnature and Pmaad Nam) Date VTime <br /> Relinquished by (Signature and Pained Name) Date I�Time Received by (signewra and Pnrded Name) Date41 <br /> D Time fl <br /> i hereby authorize ATL to perform the work Send Rep l �' Bill To ectal Instrucirons/Comments �* /� ]� x <br /> indicated below Attn Attn /: �'Z�O�--„ (�� I ! ' i" <br /> Pra)ect M r/5u ltter �f /- ! y <br /> Co �Q CjO iE CoFln `N/�7 <br /> att NArhe Date ddress1 O��_... ii I Addressl <br /> S <br /> at WCity State ZiCity State zip Q,i <br /> Sample/Records-Archival&Dish Circle or Add SPECIFY A R RIATE QA/ QC <br /> Unless otherwise requested by client,all samples will be disposed 45 days after, Analysis(es) MATRIX Z RTNE <br /> receipt and records will be disposed 1 year after submittal of final report Requested O CT ❑ <br /> Storage Fees(applies when storage is requested) t t- <br /> •Sample $2 00/sample/mo(after 45 days) ¢ < SWRCB ❑ <br /> •Records $100/ATL workorder/mo(after 1 year) <br /> w Logcode <br /> LAB,USE ONLY y` o� o� 3 Container(s) <br /> T Batch# Sample Description I� I Qin �o m2 o c�� oa =o �s' w OTHER <br /> E as �' o� m m �� OJ <br /> M Lab No Sample I D /Location mate 7tme 10� �n� �ry �o �o CoQ �� � TAT # Type REMARKS <br /> V, <br /> i <br /> i <br /> I I <br /> I ftp <br /> b09 M Cil— <br /> pi W-.-, i <br /> Overnight Emergency Critical Urgent Routine Preservatives <br /> •TAT starts 8 a m followingda if TAT A= B C= D= E_ <br /> y <_24 hr Next work da 2 rkda s 3 Workday] 7 Workda s IH=Hcl N=HNO3 zSO- C=4 C <br /> samples rec after 3 p rn <br /> Container,Types T=Tube V=V( L=Eller P= =Jar B=Tedlar i G=Glass P=Plastic M=Metal ;Z_=Zn(AC)z 0=N T=Na2S203 <br /> �TRIE d NiiIIIIIiiIIIIIIIiiith reIIIIIIII111111111111111lfello�Ider, sut� M so M <br />